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Graphic of a certificate with a
gold seal.Inside the border the text states.We provide Diplomate credentialing
and education for the fields of medicine, chiropractic, acupuncture, physical,
neuromuscular, and massage therapies. In addition to, information on
assessment and treatment options for the manual medicine practitioners and the
public they serve.

If you are legally responsible for
the interpretation of symptoms and signs this site is for you.!

We provide a free somatic quick reference
guide and site search for the review of symptoms, signs, exams, and tests.

We acknowledge and award diplomate
credentialing and provide individual support for exemplary providers who have
transformed the science of physical assessment and treatment to an art.

We have placed links on our Home page for the most pertinent topics to be
quickly referenced, however for specificity of topic and privilege to use the
entire website You must use the Search Tool

First Time Visitors Read Below

Manual Medicine

The term manual medicine was developed to
serve as a collective name for any hands on technique whereby the
practitioner/provider is attempting to create a physiological change within an
individual who is experiencing dysfunction. It may be used as a stand
alone treatment or employed as an adjunct to augment the affect of medications
and surgery. Therefore, when you see a doctor manipulate a joint and/or a
therapist, trainer, or nurse provide massage, you are witnessing manual medicine
technique. For more about the evolution of manual medicine
click
here.

Pain

Pain is an adaptive response to dysfunction, therefore, prior to experiencing
pain an individual experiences dysfunction of either the musculoskeletal system
(soma), viscera, or psyche. Over the years, there have been numerous
physiological models advanced to explain the mechanisms of pain. We have
attempted to employ commonality of thought as it pertains to evidence based
mainstream medicine as well as the concepts of the leading authors on the subject of pain. Regardless of the model, all pain
involves nerve supply, whether or not, its referral is related to trigger
points, reflex pain from diseased viscus, or exclusively related to the nerves.
Nerve pain, or its counter part, loss of sensation, is usually described as
sharp or lancinating, electrical or knife-like, numb or tingling. Throbbing pain
is usually vascular in origin. Trigger point pain is usually described as deep,
aching, or burning. However there are certain trigger points, which can produce
sharp pain, as found in the Quadratus lumborum, or in the case of the Platysmas,
numbness and tingling (paresthesia) may be exhibited.

Using shoulder pain as an example, the reader should note, that there may appear
to be discrepancies between nerve supply and dermatome patterns. Spinal nerves
C4 and C5 supply the Rhomboids and the Scalenes, yet, the dermatome referral
pattern for a C4 or C5 radiculopathy references the back of the neck and the top
of the shoulders. However, when that spinal nerve supply for whatever reason
becomes dysfunctional, the muscles that are also supplied by that nerve, may
develop trigger points and its deep aching referral pattern to the medial aspect
of the shoulder blade. Therefore, a practitioner, when viewing nerve innervation,
must not only look at the pain referral area but, also establish all the muscles
which potentially could contribute to trigger point referral and could
subsequently skew their findings based upon the subjective report of pain.
Diseased viscus or organs may also cause atypical pain referral. This can be
attributed to trigger point formation in the fascia surrounding the organ, or
due to the neurologic differentiation during fetal development. This seems to be
the most recognized reason that individuals, whom are experiencing a tubal
pregnancy or prostate cancer, would experience shoulder pain, as referenced
above. Therefore, if you exclusively use our dermatome charts, that shoulder
pain will be caused by a radiculopathy at C7, T1, or T2. If you exclusively use
the trigger point charts, that shoulder blade pain may be caused by the
Rhomboids, or the Scalenes, among others. As the Scalenes and Rhomboids are both
innervated by the Dorsal scapular nerve, which branch off from spinal nerves C4
and C5, wouldn’t a spinal nerve dysfunction at that level also be possible?
There is no substitute for a comprehensive knowledge base, therefore, when
reviewing this material you must consider dermatome patterns, trigger point
referral patterns, and the possibility of a disease process. For those that are
non-physicians this is intended to provide you with an overview of the
complexities of pain management. You should note, that frequently it requires
elaborate diagnostics established through radiographic, and/or laboratory
findings, as well as instrumentation, to determine the cause of dysfunction. And
without a physical examination and diagnostic testing, the reader may only infer
that this is scientific food for thought, but certainly cannot be solely
established to develop a course of treatment.